We all make mistakes, even very respected docs. I would either have a chat with the doc or send them to someone else, presuming you have someone accessible. It's the story that defines TT, not the visual--this dyad has a different story than presented when they saw the doc previously. Jennifer Tow, IBCLC, USA & France Intuitive Parenting Network, LLC Date: Wed, 2 Jul 2014 11:46:03 -0700 From: Michele Crockett <[log in to unmask]> Subject: What to try now? Hi Lactnetters, PTP- I am working with a mom I worked with previously with her now 2 year old son with TT not dx until 4 months and production was severely impacted. Baby #2 I saw at 4 days and identified common flags of tt, high palate, couldn't stay on breast etc. Could not feel or see a frenulum. I offered referral if mom wanted 2nd opinion and she decided to wait for a week. Week later baby had started clicking and weight was within lower normal limits. Mom ready for referral so sent her over to see an very respected tt doc who found nothing either and suggested some different positioning ideas which actually made feeding harder. Baby is now 2months 23 days. I have seen them every two weeks with average weight gain plodding along at around 4ozs per week. However, she is long so she looks very thin. Today she just didn't look good. Mom was pumping a couple times a day to protect production but stopped for a couple of weeks. She is taking Mother's Milk Plus and feels she sees more swallows. She has done one session of CST but cannot afford more although she saw a slight improvement. Stooling and fussiness have improved since mom removed all dairy from her diet. Baby requests feeding about every 2 hours and while mom says she is done in about 10-15 minutes, observing her feeding today I saw that baby never relaxed during the feeding, mom is holding the breast in baby's mouth, and baby is off and on once the MER is over and I suspect baby stopped feeding not from satiation but from muscle fatigue. Clicking with every suck during the MER. I was able to get baby to suck on my gloved finger (why don't they make milk flavored gloves!?) and the posterior tongue is totally humped up, when I massage it down she starts gagging. Minimal negative pressure.... I've recommended re-starting pumping (I seriously doubt this little gal can maintain production much less increase it) and supplementing with cup or bottle. This totally walks like a duck (tt) and clucks like a duck (tt) but I cannot see or feel where the restriction is. Should we consider another MD eval? Should we request referral for OT? Ideas of where to go, please! Thanks, Michele -- *Michele L. Crockett, IBCLC, PCPA, LLLL* *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome ------------------------------ End of LACTNET Digest - 1 Jul 2014 to 2 Jul 2014 - Special issue (#2014-329) **************************************************************************** *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome